NPIMap

Individual provider Active NPI

Neelesh S Bangalore, MD, PHD

  • Specialist
  • Tracy, CA
National Provider Identifier
1154326262
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A70883 Issued in CA
Practice address
4600 S Tracy Blvd Ste 108
Tracy, CA 95377-8105
Phone
(209) 839-9115
Fax
(209) 833-7262
NPI assigned
Jun 15, 2005
Last updated
Jun 25, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A70883 CA Primary

Addresses

Primary practice location

4600 S Tracy Blvd Ste 108
Tracy, CA 95377-8105

Mailing address

PO Box 7667
Stockton, CA 95267-0667
Phone (209) 839-9115

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040618000569 CA Practitioner - Hematology 9739163478 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stockton Hematology Oncology Medical Group IncGroup PAC ID 1456369800, 9 clinicians

Practice addresses (Care Compare)

1325 Melrose Ave
Suite a
Modesto, CA 95350-5581
Phone (209) 524-7000

2316 Orchard Pkwy
Suite 100
Tracy, CA 95377-7324
Phone (209) 839-9115

2626 N California St
Suite B
Stockton, CA 95204-5500
Phone (209) 466-2626

2626 N California St B
Stockton, CA 95204-5500

300 Northgate Dr
Manteca, CA 95336-3139
Phone (209) 665-4782

801 S Ham LN
Suite S
Lodi, CA 95242-7503
Phone (209) 366-2616

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.02 of 100Reported as group
Quality
71.01
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
A70883CAMDSpecialist
70883CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Mar 25, 2020 Accepting new patients
Stockton Hematology Oncology Medical Group, Inc Specialist CurrentSince Jul 1, 2016 Accepting new patients
Sutter Tracy Community Hospital Past Accepting new patients
St. Joseph's Hospital, Yonkers Past Accepting new patients
Port City Operating Company, LLC Past Accepting new patients
Dameron Hospital Association Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
San Joaquin Hematology/Oncology, a PC Specialist Past Accepting new patients
Doctors Hospital of Manteca, Inc. Past Accepting new patients

Locations

801 S Ham Ln
Ste S
Lodi, CA 95242
Phone (209) 333-8066

300 Northgate Dr
Manteca, CA 95336
Phone (209) 665-4782

1325 Melrose Ave
Ste A
Modesto, CA 95350
Phone (209) 524-7000

700 Mountain Ranch Rd
Ste B
San Andreas, CA 95249
Phone (209) 754-9670

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

1801 E March Ln
Ste B260
Stockton, CA 95210
Phone (209) 474-1458

2626 N California St
Ste B
Stockton, CA 95204
Phone (209) 466-2626

2626 N California St
Ste H
Stockton, CA 95204

2626 N California St
Ste L
Stockton, CA 95204

4600 S Tracy Blvd
Ste 108
Tracy, CA 95377
Phone (209) 829-9115

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.prod.flatiron.io/fhir/
  • Direct secure messaging: nbangalore18720@hisp.ehr.sutterhealth.org

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340582400000",
    "number": "1154326262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7667",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670667",
            "telephone_number": "209-839-9115",
            "fax_number": "209-833-7262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 S TRACY BLVD STE 108",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953778105",
            "telephone_number": "209-839-9115",
            "fax_number": "209-833-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANGALORE",
        "first_name": "NEELESH",
        "middle_name": "S",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2012-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A70883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

Verify at the official NPI Registry.